Healthcare Provider Details

I. General information

NPI: 1063599793
Provider Name (Legal Business Name): DAN WALKER MYERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WILLIAMS WAY
CHAPIN SC
29036-8077
US

IV. Provider business mailing address

113 WILLIAMS WAY
CHAPIN SC
29036-8077
US

V. Phone/Fax

Practice location:
  • Phone: 770-833-4161
  • Fax:
Mailing address:
  • Phone: 770-833-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDNO12029
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9813
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier582628995
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerTAX ID #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: